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Chapter 10 Comfort and safety 中国医科大学护理学院 曹 颖 Objectives 1. Describe “ Comfort, pain” 2. Identify the etiologies causing discomfort 3. Describe the nursing care of clients with pain 4. Understand the functions of common positions. 5. Know the usages of protective devices, crutches and canes. Section 1 To Meet Comfort Need • • 1. Comfort: strengthen greatly, renewal *(1) Definition:a mental state of physical and psychological health, no pain no anxiety and relaxing at ease. subjective feeling, a positive mind-set client-led & nurse-controlled * (2) Highest level of comfort: all need are met (3) Related factors a b c d Physical comfort needs Psychospiritual comfort needs Social comfort needs Environmental comfort needs 2. Discomfort (1) Etiology *(2) Manifestation irritation insomnia fatigue depress loss despair pain (3) Nursing A solace: talking in soothing tones B providing a warm blanket a cup of tea C maintaining a quiet environment D coordinating the activities of other staff E supporting: medical staff. the clients family members or significant others F touch, applying lotion to dry skin G encouraging decision making 3 The methods to improve comfort Position Active Position passive Position Compulsory Position Stable Position Unstable Position Position supine position: dorsal recumbent P side lying position: lateral P Fowler’s position: Semisitting P orthopneic position prone position trendelenburg position dorsal elevated position knee chest position lithotomy position a b c d e f g h i Section 2 Pain **1. Definition An unpleasant sensory and emotional experience associated with actual or potential damage or described in terms of such damage. * 2. Nature Physiologic and psychologic subjective and individual body’s defense mechanisms 3. Types of pain (1) According to its origin a Cutaneous pain:skin, subcutaneous b Deep somatic pain: ligament, bone, nerves c Visceral pain: abdominal cavity, cranium (2) According to where it is experienced in the body a Radiating pain b Referred pain C According to duration a acute pain b chronic pain D Intractable pain E Neuropathic pain F Phantom pain G Pain syndromes 4 Precipitating factors a chemical factors: b Physical factors: temperature, incision, c pathological factors: diseases d. Emotional factors: 5 Concepts associated with pain pain threshold is the amount of pain stimulation a person requires in order to feel pain pain tolerance is the maximum amount and duration of pain that an individual is willing to endure 6 Factors affecting the pain experience a Ethnic and cultural values b Developmental stage c Past pain experiences d Attention e Emotion: Anxiety and stress F Individual difference G Social support system H Medical staff 7 NURSING (1) ASSESSING A Pain history B Effect on activities of daily living C Sounds and posture D Coping resources E Intensity, quality and location Grade (score) 0 : no pain 1 : mild pain ,can tolerance ,do not disturb sleep 2: moderate pain ,can not tolerance , disturb sleep ,need drug 3: severe pain , can not tolerance , disturb sleep seriously ,need drug * Measure Methods a Numerical rating scales b Verbal descriptors scales c Visual analogue scales DIAGNOSING Ineffective airway clearance Anxiety Ineffective individual coping Altered health maintenance Knowledge deficit Impaired physical mobility Sleep pattern disturbance **IMPLEMENTING 1) pain management A pharmacologic First stage NSAIDs (non steroid anti-inflammatory drugs) Nonopioids (nonarcotic) analgesics Antipyretic Second stage Opioid analgesics (codeine) Third stage Opioid analgesics (dolantin morphine) Assistant drug Valli B nonpharmacologic (physical) a Heat and cold application b TENS (transcutaneous electrical nerve stimulation) c massage acupressure C acupuncture D immobilization 2 psychological nursing a reduce mental pressure **b distraction * distraction activities (playing, watching TV, singing, enjoying music) * relaxation technique * imagery * therapeutic touch * hypnosis * bio-feedback * meditation * Message 3 promote comfort EVALUATING Section 3 Safety 1 Factors affecting safety mechanical injury physical injury chemical injury biological injury nosocomial injury 2 Device to prevent injury A. protective devices bedside rail restraints safety strap body restraints overbed cradle B. assistant devices crutches canes